Out of This World

I admit it – I’ve spent hours watching the reports of Malaysian Flight 370.  It’s bizarre and fascinating to me that, in this day, a Boeing 777 could just vanish.  How does that happen?  How can something as big and strong – as vibrant, event – as big jet airplane just go away?

In the world of trauma, we’re pretty good at keeping people around.  You may not be as good as when you first came to us, but…still, we tend to keep most of our patients alive.  People generally just don’t go away.   

But the other night that wasn’t the case.  An elderly man had a heart condition that necessitated a very powerful blood thinner.  His old, loyal cat got stuck on their roof, and for some reason this man decided to go after it.  He slipped and fell off, breaking his back in this process.  He had been a heavy smoker, and when people when bad hearts and bad lungs break their backs they get really sick.  One by one his organs began to rapidly fail him, until we were keeping him alive with a ventilator, massive amounts of blood transfusions, and vasopressors. 

The problem is that when someone gets such a massive amount of fluids, their intestines and abdomen get incredibly swollen.  This man’s swelling got so severe that it was affecting his breathing.  It’s called abdominal compartment syndrome, and the only cure is surgery to decompress the abdomen.  Unfortunately this man was too sick to even transport to the OR, and so we had to bring the operating room to him. 

And that’s just what we did.  In a flash of nurses and techs, a small, mobile OR was brought to the man’s bedside.  His skin was rapidly cleaned, I got scrubbed, and before anyone even knew what was happening I was opening his belly.  I made a huge incision – from his pubic symphasis all the way to his xyphoid – as quickly as I could.  I cut down past his muscles, through his fascia, and into his abdomen. His intestines burst out with a rush of fluid as the pressure was released. 

And quite rapidly he got better.  His oxygenation improved, and his blood pressure and heart rate normalized.  He was so close to death – so close to vanishing – and now here he was, showing us he was alive.  We got some supplies that we could use to temporarily cover his abdomen and went back to work, thinking that we had at least staved off death for now. 

But then he started bleeding.  Just as I was finishing we noticed blood welling up from beneath his liver.  His blood pressure started to drop, and I had to open up my closure.  The blood thinner was still in his system (some cannot be reversed, and this was one of them), and he was bleeding out.  When patients have a discrete injury it can targeted and ligated, but this patient was just bleeding from everywhere.  We tried to compress the bleeding but it didn’t work.  Dissecting just seemed to make it worse.  We packed and packed his abdomen to try and stop it, but all that did was stop the blood flow back to his heart.  Within a few short minutes his heart stopped. 

And that was it; he was gone.  He had been a vibrant man – a husband, a father – just a few short hours before.  And in a flash he had disappeared from his family forever. 

The family was gratefully for our efforts, but clearly devastated.  And so was I. 

I don’t really think we did anything wrong – I think he was just a really sick man who had a bad accident, and it was just too much for him.  And sometimes that happens.  Sometimes people vanish off this planet without a more satisfying explanation.